Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). A small joint is also formed between the shin-bone and the calf bone (fibula).

Symptoms: Pain when applying pressure, and when stretching the tendon or ligaments which are attached to the bone where the tear has occurred.

Acute treatment: Click here.

Examination: Normal clinical examination is often sufficient. Larger tears can be seen on an X-ray. Many lesser tears can be best seen via an ultrasound scan, from which an inflammation surrounding the tear can also be seen (Ultrasonic image).

Treatment: Minor tears merely require relief from the pain inducing activities. Larger tears can require surgery. Some cases can cause prolonged discomfort with pain that does not recede despite relief. This can be due to the tear causing chronic inflammation in the tissue. In such cases, rheumatic medicine (NSAID) or injection of corticosteroid in the area surrounding the tear can be recommended.

Rehabilitation: Rehabilitation is totally dependent upon the type of tear, and the treatment (conservative or surgical). The tears on the inner side of the knee are usually re-trained in the manner of inner collateral ligaments ruptures, whilst tears externally to the knee are re-trained asouter collateral ligament ruptures.
Also read rehabilitation, general.

Complications: If smooth progress is not achieved it should be considered whether the diagnosis is correct, which will often require supplementary examination (X-ray, ultrasound scanning or MR scanning). The following should especially be considered:

• Meniscus lesion
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Cartilage damage (osteochondral lesions)
• Tendonitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Inflammation of the mucous fold

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). A small joint is also formed between the shin-bone and the calf bone (fibula).

Symptoms: Sudden insetting pain which is aggravated when applying pressure and when applying load or strain. The symptoms are dependant upon which bone is broken. In cases where the knee cap is cracked right across, the stretching function will discontinue.

Acute treatment: Click here.

Examination: Medical assistance (casualty ward) should be sought immediately if there are any suspicions of a bone fracture in order for the diagnosis to be confirmed by X-ray examination. A fracture in the growth zone surrounding the knee can be difficult to determine in children and adolescents.

Treatment: Treatment is completely dependent upon the type of fracture, and can consist of relief, bandage/plaster cast or operation.

Rehabilitation: Rehabilitation is totally dependent upon the type of fracture, and the treatment (relief, bandage/plaster cast or operation). All attempts must be made to preserve the muscle strength in the thigh and shin bone as far as possible, and the mobility of the knee joint.
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition a medical examination should be performed once more to ensure that the fracture is healing according to plan..

Specielt: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

Anatomy: A strong tendon (tractus iliotibialis) runs externally from the hip crest to the shin-bone, upon which many the thigh muscles fasten.

Symptoms: Slowly insetting pain externally on the knee, aggravated when applying pressure, when stretching the iliotibial tract and running.

Acute treatment: Click here.

Examination: The diagnosis can usually be made on the basis of a normal medical examination. If there are any doubts regarding the diagnosis, an ultrasound scan (or MR scan) is recommended.

Treatment: Treatment comprises relief, stretching of the iliotibial tract and rehabilitation. It is imperative that footwear has good shock absorbing soles. An incorrect foot posture should be corrected by use of special shoes or insoles. If progress is not forthcoming, medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid can be considered. A surgical splitting of the ligament can be performed in sever cases which do not react to relief, correct rehabilitation or medicinal treatment (article).

Complications: If smooth progress is not achieved it should be considered whether the diagnosis is correct, which will often require supplementary examination (X-ray, ultrasound scanning or MR scanning). The following should especially be considered:

• Meniscus lesion
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Tendonitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Inflammation of the mucous fold

Special: Shock absorbing shoes or inlays will reduce the load in the knee. In case of lack of progress or recurrence after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style is indicated.

Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae), where children and adolescents have a growth zone. The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

Symptoms: Slowly insetting tenderness at the upper, front part of the shin bone (tuberositas tibiae) during and after the sports activity. If the discomfort has a long duration, the bone fastening on the shin bone will become more prominent and can become so large that kneeling will be a problem. It is especially boys in the 10-16 age group that have the symptoms, and the condition is very common and can be seen in almost all boys’ football teams. The symptoms will diminish at around age 17 when the growth zone on the shinbone closes.

Acute treatment: Click here.

Examination: The diagnosis can usually be made with certainty under a normal medical examination, revealing localised tenderness on the knee cap fastening on the upper, front part of the shin bone. If there is any doubt surrounding the diagnosis an ultrasound scan can be performed to identify the changes (Ultrasonic image), however, this is seldom necessary in uncomplicated cases (article).

Treatment: The treatment comprises relief from the pain inducing activity (jumping, kicking). The injury can in some cases heal within a few weeks if the treatment is instigated quickly whereas a rehabilitation period of several months must be anticipated if the pain has been in evidence for some months. Emphasis is placed on stretching of the anterior thigh muscle. Ice treatment can be repeated every time tenderness is provoked in the knee cap ligament fastening during the rehabilitation period. If during the rehabilitation period pain is experienced when walking, medicinal treatment in the form of rheumatic medicine (NSAID) in gel form. Injection of corticosteroid should not be considered in the treatment (article). The sports activity can be cautiously resumed when the pain has diminished. Relapses will often occur, which should be followed as soon as possible with a period of relief. During the relief period it will usually be sufficient to abstain from the most stressful exercises (jumping), whilst many other training exercises can be performed without discomfort. In the majority of cases it will be therefore be possible to participate in at least a part of the sports activity (for example as goal-keeper).

Bandage: Some patients have the opinion that the application of tape or bandage around the shin bone directly under the knee cap can relieve the discomfort (tape-instruction).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct or whether complications have arisen. Special consideration should be given to:

• meniscus lesion
• cartilage damage (osteochondral lesions)
• bone membrane tear (periosteal avulsion)
• tendonitis
• bursitis
• inflamed mucous fold (plica synovialis)

Kun i meget sjældne tilfælde er der beskrevet afrivning af knæskalssenen fra fæste på skinnebenet. Den afrevne knogledel (hvorpå knæskalssenen fæster) kan ved en operation skrues fast på skinnebenet igen. (article).

Special: Shock absorbing shoes or inlays will reduce the load on the knee.

Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

Symptoms: Sudden insetting pain in the knee cap ligament directly under the knee cap, where there is often a sensation of feeling and hearing a “snap”. Pain when activating the anterior thigh muscle (rising up from a squatting position, running and walking), pressure on the ligament and when stretching (anterior thigh muscle). A defect can often be felt in the ligament if a total rupture, and active stretching of the knee is impossible.

Acute treatment: Click here.

Examination: In all cases when there is a sense of a “snap”, or sudden shooting pains in the ligament with difficulty in stretching the knee, medical attention should be sought as soon as possible. Ultrasound scanning is used to advantage when making the diagnosis, as even considerable ruptures can be easily overlooked without the aid of ultrasound scanning. A swift diagnosis is of great importance for the result of the treatment (article). An ultrasound scan should be performed which will enable an appraisal of the extent of the changes in the ligament: total or partial rupture, inflammation in the tendon (tendonitis), scar tissue formation (tendinosis), calcification in the tendon, bursitis and inflammation of the tissue surrounding the tendon (peridenitis) (Ultrasonic image) (article).

Treatment: Ruptures require swift operation as delay in making the diagnosis will cause a poor result. An injury period of 6-9 months must be anticipated before the sports activity can be resumed at the same level (article).

Complications: A new ultrasound scan should be performed if no progress is in evidence to exclude a new (partial) rupture of the knee cap ligament and:

• Bursitis
• Bone membrane tear (periosteal avulsion)
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Cartilage damage (osteochondral lesions)
• Cartilage damage on the knee cap
• Meniscus lesion
• Inflamed mucous fold (plica synovialis)

It will relatively often not be possible to resume the sports activity at the same level despite correct attempts at treatment and rehabilitation.

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

Symptoms: Jumping and similar activity will initially cause tenderness at the lower edge of the knee cap. The pain diminishes during the first weeks/months after warm-up. If the sport activity continues the pain will increase, resulting in the activity eventually becoming impossible.

Acute treatment: Click here.

Examination: Correct treatment from the outset is essential for a good result. A medical examination is consequently recommended as soon as possible after the initial onset of pain under the knee cap. The diagnosis is often made following a normal medical examination. At deterioration or lack of progress, an ultrasound scan should be performed which will be able to reveal a thickening of the ligament, granuloma, scar tissue formation, partial rupture, calcification in the ligament, bursitis and inflammation of the tissue surrounding the ligament (peridenitis) (Ultrasonic image) (article).

Treatment: The treatment consists of relief from the pain inducing activity (jumping, kicking) as soon as possible after the onset of symptoms. The injury can in some cases heal within a few weeks if the treatment is instigated quickly. A rehabilitation period of several months must be anticipated if the pain has been in evidence for some months, and especially if an ultrasound scan has found thickening or changes of the ligament. Emphasis is put on stretching and strength training of the anterior thigh muscle, by activating the muscle simultaneously with stretching (eccentric training). Ice treatment can be repeated every time tenderness is provoked in the knee cap during the rehabilitation period. If there is a lack of progress following relief and strict rehabilitation, medicinal treatment in the form of rheumatic medicine (NSAID) can be considered, or injection of corticosteroid in the area surrounding the thickened part of the ligament. Research has shown that ultrasound guided injection of corticosteroid is extremely effective in reducing the extent of the thickened ligament, allowing more active rehabilitation to begin (Ultrasonic image) (article-1), (article-2). As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or rupture. The ligament is naturally unable to accommodate maximum strain or load after a prolonged injury period following only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected (article). It is not unusual for a rehabilitation period of six months before maximum strain or load in the form of jumping is permitted. During recent years, different types of experimental treatment have been seen such as sclerosis injection (where injections are performed around the tendon with a drug to destroy the small blood vessels (and nerves) that infiltrate the sick tendons), and shock-wave (ultrasound treatment). However, there is no sure or clear documentation for the effect of these kinds of treatment. If satisfactory progress is not made in the rehabilitation and conservative treatment, surgical intervention can be considered. Long-term results of operations are often disappointing (article).

Bandage: Some patients have the opinion that the application of tape or bandage around the shin bone directly under the knee cap can relieve the discomfort (tape-instruction).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct or whether complications have arisen. Special consideration should be given to:

• Meniscus lesion
• Anterior cruciate ligament rupture
• Posterior cruciate ligament rupture
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Tendonitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Inflamed mucous fold (plica synovialis)
• Knee cap ligament rupture

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). The joint cavity is coated with a very thin synovial membrane.

Symptoms: Swelling of the joint. Pain upon movement of the knee joint. Trouble flexing the knee completely.

Acute treatment: Click here.

Examination: Swelling of joints always requires medical examination. The diagnosis is usually made following a normal medical examination, where it is not possible to show damage to other structures (ligaments, meniscus). Smaller fluid accumulations in the knee can only be seen with ultrasound (article).

Treatment: Relief. If the swelling does not decrease despite relief, the treatment can be supplemented with medicinal treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid in the joint, possibly preceded by drainage and evaluation of the joint fluid which can advantageously be performed under ultrasound guidance (article).

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Cartilage damage (osteochondral lesions)
• Outer collateral ligament rupture
• Inner collateral ligament rupture
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Meniscus lesion
• Inflamed mucous fold (plica synovialis)
• Degenerative arthritis (osteoarthritis)

Anatomy: The tendons from the thigh to the shin bone pass the knee joint on the inner and outer sides, as well as to the front and rear of the knee.

Symptoms: Pain upon applying pressure along the tendon, aggravated when stretching or activation of the muscle tendon.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in slight cases. Severe cases or cases that are not improved by relief should be medically evaluated to ensure a precise diagnosis. The diagnosis is usually made on the basis of a normal medical examination, however, if any doubts surround the diagnosis an ultrasound scan can be performed as this is the best type of examination to ensure the diagnosis.

Treatment: Relief, stretching and slowly increasing load within the pain threshold. If there is not sufficient progress with relief and regular rehabilitation, medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid along the inflamed tendon can be considered. As the injection of corticosteroid is always a part of a long term rehabilitation of a chronic injury, it is often necessary for the rehabilitation period to stretch over several weeks to reduce the risk of relapse and ruptures. The tendon is naturally unable to accommodate maximum strain or load after a prolonged injury period after only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning and the injections are performed under ultrasound guidance, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected. In cases of lack of progress with rehabilitation and medicinal treatment, surgery can be considered. However, this is very rarely necessary after a regular and strict rehabilitation period.

The rehabilitation is dependant upon which tendons are involved, but it is usually the tendons in the popliteal space of the knee (tendons contributing to the flexing of the knee).

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Meniscus lesion
• Inflammation of the mucous fold
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Inner collateral ligament rupture
• Outer collateral ligament rupture
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis

Special: Shock absorbing shoes or inlays will reduce the load. In case of lack of progress or recurrence after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style is indicated.